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Permit S' CITY TIGARD PLUMBING PERMIT ., DEVELOPMENT SERVICES PERMIT #: PLM2005 -00428 `� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/2/2005 PARCEL: 2S 115AA -09400 SITE ADDRESS: 16260 SW 108TH AVE ZONING: R -25 SUBDIVISION: SWARTWOOD PARTITION LOT: 001 JURISDICTION: TIG Project Description: Replace water line. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 272 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES GRACE SWARTWOOD Description Date Amount 16260 SW 108TH AVE TIGARD, OR 97224 [PLUMB] Permit Fee 9/2/2005 $147.80 [TAX] 8% State Surcharl 9/2/2005 $11.82 Phone : 503 639 - 9203 Total $159.62 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone: Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: Permittee Signature: �•�, , `!` _ �: .r _ 1,=,ar/ Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. . • Building Fixtures �VE® Plumbing Permit Apipli o 9 0n oiz oFhl use ONLY - CI of TI and Received l _/) ^- (� �' g SR o � .. D ate/By. 9 ,off (/ �' Permit No \ 0 �6 e ,/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review TIG ti ?��J Phone: 503.639.4171 Fax: 503.598.1960 AVIC' / /".'ti,u i, i\ Other Permit No.: I 24- Hour Inspection Line: 503.639.4175 Ca D ��c� .� . Date/By: I, Date Ready/By: lung: El See Page 2 for • Internet: www.ci.tigard.or.us DID gU1L Notified/Method: Supplemental Information TYPE OF WORK . . FEE *. SCHEDULE _ . ❑New construction ❑Demolition For special information use checklist. I. Description 1 Qty. 1 Ea. 1 Total ❑ Addition /alteration/replacement Q Other: 014 lit water / 11'1 e.. , New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION ' , , ' , . SFR(1)bath . . 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 ❑ Mastcr builder Each additional bath/kitchen 45.00 Other: p 01/G tN0.ter /t rl e Fire sprinkler ( sq. ft.) Page 2 JOB • SITE INFORMATION ,AND LOCATION Site utilities ' Job site address: / .. 6 o Sw / ()ell / h e • Catch basin or area drain 16.60 City /State /ZIP: T , �.4 0 R q-7...2- j( Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: I� Manholes 16.60 � k / 00. an, Rd. . - /d0 o 4 7 . 6 Rain drain connector 16.60 . Sanitary sewer (no, linear ft.: ) Page 2 � .. 11 Storm sewer (no. linear ft.: ) Page 2 5k Subdivision: 10.r'tw 0 . 4, �dl.'r l ; Ti 0.1 Lot no.: / Water service (no. linear 11.:2.73.. 3 Page 2 / y7 8° Fixture or item Tax map /parcel no.: e2. 511 S /IA -0 9 V O 0 Absorption valve 16.60 DESCRIPTION OF WORK .�,,,qq__ Backflow preventer Page 2 M.0 v e Wet "Otte tes . I n G 'Fif 4�p:t f {�yvt,1el,.l-� Backwater valve 16.60 tite O r41 ) 1 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 I�Y�ROPERTY OWNER ❑TENANT ' • a Ejectors/sump 16.60 Name: a, K .oQr .} t. d O a 4• Gram. j U&C I 'W OO J Expansion tank 16.60 Address: / 4, Z..(0 0 S 1.0 / 0 I--#4 / 147e Fixture /sewer cap 16.60 City /State /ZIP: T3, 4„,74_ a. ©ie_ ?IL I. V Floor drain/floor sink /hub 16.60 (5 3 6 3 q - 9 x 0 3 F a x: ( ) Garbage disposal 16.60 Phone: • lid' APPLICANT ❑ CONTACT PERSON Hose bib 16.60 • • Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: L- r a , e t , , , Medical gas (value: $ ) Page 2 Address: //_ LG D SW /0 ,144vY . Primer 16.60 City /State /ZIP: VV'' 7 a ri O/2 97 2:a. Lii Roof drain (commercial) 16.60 • Sink/basin/lavatory 16.60 Phone: ( 6-0 3 6 3 91_9 a O 3 Fax:: ( ) Tub /shower /shower pan 1 6.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Water heater 16.60 Address: Other: 1 Subtotal / Y7 0 City /State /ZIP: Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) //, Y'. �� State surcharge (8% of permit fee) / Authorized signature:,,� TOTAL PERMIT FEE / 5i /� 0 . Print name: G r'otC e v W ar+ 1/jock Date: 9/ 2.10 S This permit application expires if a permit is not obtained within • 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. is \BuildingWermits \PLMF- PermitApp.doc 06/05 4404616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities_ g . . - m , , Qty= `Fee (ea)' Total Square °Footage: Permit =Feel, , .' Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,60.1 to 7,200 $220.00 . Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' I 55.00 5s • - Medical Gas Systems: Water Service - each additional 100' Z 46.40 Qa r Valuation: .Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00. and $1.52 for each ' additional $100.00 or fraction thereof to and Fi or Ite °` Qtr•Fe'e (ea) Total Commercial Back Flow Prevention Device 46.40 including 148. i0g for the first $ $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. , Rain Drain, single family dwelling 65.25 $25,001.00 to $50;000.00 ' $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or 'each additional $100.00`or.fraction thereof to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $ 1.20 for each additional $100.00 or fraction thereof ' - Fixture Work: - ° ` • _ - Plan Review ;for Complex ° Stru'ctures Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined;as ah installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity by (Fixture) Work Performed ' , , , ❑ Any new com mercial building. , . . . Fixture Type: Replace , ° ❑ AIV new exterior plumbing site utilities. . . Previous Capped Added Existing ❑ A commercial, building with installation; alteration or • Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. . . Car Wash -Each Stall - • . • -❑ Plumbing installations, alterations or additions to•food.service -Drive Thru . facilities where new'plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food serbice area. ' Dishwasher - Commercial ❑ Any new residential building containing•three (3) or more - Domestic dwelling units. ., Drinking Fountain CI Any NFPA 13 - multipurpose fire sprinkler system. . Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" 4 „ Car Wash Drain - Isometric :or RiserDiagram Garbage - Domestic ❑ Isometric riser diagram is required,for new buildings Disposal Commercial three (3) or more stories in height. - Industrial , • Ice Mach. /Refrig. Drains • Oil Separator (Gas Station) Comments regarding fixture work: ' - Rec. Vehicle Dump Station . Shower -Gang -Stall Sink - Bar/Lavatory - Bradley ' ` - Commercial • - Service Swimming Pool Filter Washer - Clothes • *Note: If the fixture work under this permit results in an Water Extractor p Water Closet - Toilet increase of sewer EDUs, a sewer permit, will be issued and Urinal fees assessed -for the sewer increase must be paid before the Other Fixtures: . . plumbing permit can be issued. • i:\ Building \Pertnits\PLM- PermitApp.doc 07/06/05 7 t.. CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2000042 8 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/2/2005 g Phone: (503) 639 -4171u i ilk, ii Inspection Requests (24 Hrs.): (503) 639 -4175 °''_I.. INSPECTION WORKSHEET FOR DATE: 912012005 TIME: 7:07AM PAGE: 73 SITE ADDRESS: 16260 SW 100TH AVE CLASS OF WORK: SUBDIVISION: SWARTWOOD PARTITION LOT #: 001 TYPE OF USE: PROJECT NAME: StJIARTWOOD DESCRIPTION: Replace water line. OWNER: SWARTWOOD, GRACE PHONE #: 503-639-9203 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9120/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 016077 -01 503. 639.9203 N Corrections /Comments/ Instructions: ..7,.._) ./t a; -ASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS • FAIL 1 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 0 Date: / 1 i Phone #: (503) 718-